新生儿幽门梗阻腹腔镜手术麻醉的临床观察

A clinical study of anesthesia during laparoscopic pyloromyotomy in neonates

目的观察在新生儿腹腔镜幽门环肌切开术中使用不同的麻醉方法,CO2气腹对呼吸循环系统功能和拔管的影响。方法全麻组(Ⅰ组)和硬膜外加浅全麻组(II组)各30例,在注气前、气腹中、注气毕记录各时点的呼吸循环动力学指标并加以比较。结果两组病例气腹后,心率、MAP、PETCO2、最大吸气压(PIP)、PaCO2与注气前基础值相比均明显增高,pH值明显下降,SaO2值没有显著性变化。拔管前所有数值转为基础值;硬膜外麻醉组拔管时间明显缩短。结论新生儿气腹可以引起呼吸循环功能的改变,两种麻醉方法均安全可行,使用硬膜外麻醉可以使镇痛镇静完全,肌松良好,苏醒及时。

[Objective] To observe cardiorespiratory changes during carbon dioxide insufflation in neonates undergoing laparoscopic pyloromyotomy under different anesthesia. [Method] 60 neonates were divided into two groups： general anesthesia（group 1） and epidural anesthesia combined with general anesthesia （group 2）. Intraoperatire ventilatory management included a tidal volume of 10ml/kg, with the rate adjusted to achieve an end-tidal CO2 （PETCO2） of 30 to 45 mmHg. Respiratory and hemodynamic data were measured before CO2 insufflation, CO2 being insufflated into peritoneal cavity and the end of operation. [Result] Compared with the baseline value, HR, MAP, PETCO2 PaCO2 were significantly increased after peritoneal insufflation, pH was reduced significantly and SaO2 was not changed significantly. All data returned to normal level before extubation. The recovery time of group 2 was much more rapid than of group 1. [Conclusion] There were minimal changes in cardiorespiratory function during neonatal carbon dioxide insufflation. Epidural anesthesia can be safely applied to neonates with congenital hypertrophic pyloric stenosis during laparoscopic pyloromyotomy.